Latina Promotoras Educate Farmworkers 

Diabetes Control is the Message 

By Brigette Settles Scott, MA


Closing the Gap, First Summit Packs the House • January/February 2003


At the Centers for Disease Control and Prevention (CDC), 

Racial and Ethnic Approaches to Community Health 

(REACH 2010) is a cornerstone initiative aimed at eliminating disparities in the health status experienced by ethnic minority 

populations in six priority areas—cardiovascular disease, immunizations, breast and cervical cancer screening and management, HIV 

infections/AIDS, infant mortality, and diabetes. 

One coalition charged with heeding the call to reduce morbidity 

and mortality related to type II diabetes in the Texas Rio Grande 

Valley is the REACH Promotora Community Coalition. Led by 

Migrant Health Promotion, a community-based nonprofit organization that develops, implements, and evaluates peer health educator 

programs in farmworker communities nationwide, the coalition brings 

together seven distinct agencies in collaboration with local, state, and 

national advocacy organizations. Each intervention of the coalition 

combines health education with advocacy for community and system 

changes that support healthy lifestyles. 

Models that Work 

Building on its 1996 Department of Health and Human Services award for models that work, Migrant Health Promotion is extending its promotora (lay or peer health educator) model by implementing an intensive diabetes education program in the Texas-Mexico 

border region. 

“Promotoras is a model that works in Mexican American communities on the border, and that model would exist with or without 

funding. It’s an informal leadership model of creative ways people get 

their needs met when they don’t have access to services. So, by superimposing some training, funding, and technical assistance on top of a 

model that already exists, it is truly the way community intervention 

should function. The community decides what works best for it. 

That seems to be what has risen out of the promotora model,” said 

Laura Regan, REACH program director. 

The typical promotora is about 30, female, and Mexican American. She is usually a more mature woman who has taken on the 

leadership role in the community. She usually has children herself, 

and may or may not be married. Overall in the coalition, there are 22 

trained promotoras who each receive 200 hours of training. 

“The training our promotoras receive includes information on 

anatomy, diabetes risk factors, complications of diabetes, medical treatment of diabetes, gestational diabetes, leadership, communication and 

advocacy, nutrition and physical activity, and how to work with the 

community to conduct health fairs,” said Regan. 

The Coalition has three different areas of intervention: clinic, 

school, and community. Three clinics conduct the clinical interventions. Promotoras, working with clinic staff, conduct home visits or 

accompany patients when they visit their health care provider

syste

s. The school component is charged with making 

mic change using CDC’s school health index. Three 

schools are implementing the recommendations. “So far, each school 

has been successful in getting rid of the snack and soda machines, as 

suggested by the school health index,” said Regan. “Others have 

secured funding through REACH to add water filtration systems.” 

For the community outreach component, promotoras offer inhome support and education to residents on diabetes and are leading 

walking groups and conducting cooking classes with Mexican American residents in the valley. All services are provided in Spanish, and the 

promotoras use a variety of different materials and techniques to enhance learning and understanding. “One of the tools the promotoras 

use is a pictograph. Even in Spanish we have a low literacy rate, so 

even if you have good translated Spanish materials it might not service 

literacy needs. For example, promotoras use pictures that depict someone being thirsty—like holding their throats to indicate excess thirst— 

and relate that as being a symptom of diabetes. That’s just one example, but there is a symptoms list that’s all pictograph-related. It’s 

really powerful to go to one of these homes to watch the promotoras in 

action. The communication is really profound. Promotoras also have 

a training curriculum where we try really hard to expose them to other 

resources and agencies,” explained Regan. 

Grassroots in Action 

Carmen Soto, a lay health educator has found the interventions 

to be rewarding to herself and her family, and has noted marked 

improvements in the healthy behaviors adopted by many residents. 

“I’m a health promoter, and work with the REACH program in 

Progresso, TX, where I also live. I’ve been working for a year and half, 

and like it a lot. I can see changes in my community already. People 

are walking and involved in physical activity, have changed their 

cooking habits by using less fat when they cook, and they don’t use 

much salt because it compromises health. One of the most empowering things that I’ve seen is that we’ve taught people to read labels, and 

to my knowledge, that hasn’t happened before. I get comments all the 

time when we conduct that particular session in the community. 

They say things like, ‘Oh I never read that, I just buy what’s on sale,’” 

explained Soto. 

“Another thing that I’ve seen happen is that people now understand what the blood pressure numbers mean. In the past, the doctor 

would be a little patronizing with them, and say that ‘you’re fine, your 

blood pressure’s fine, your sugar’s fine. Before, people would never 

ask what the numbers were, what they meant, or how close to the 

border of risk they truly are. But now, folks feel that they can advocate 

for themselves a little better.” 

Outreach activities are usually tailored to specific community 

needs. The promotoras first conduct outreach in a specific block area, 

where they go door-to-door, show the pictograph about the symptoms of diabetes, and recruit participants on the spot. 

n 

> 

According to Soto, many residents want the preventio

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Office of Minority Health Resource Center 1 U.S. Department of Health and Human Services 
Latina Promotoras Educate Farmworkers Thank You

Diabetes Control is the Message 

By Brigette Settles Scott, MA


Closing the Gap, First Summit Packs the House • January/February 2003


interventions, and as a result, are able to unite the folks who express 

an interest, bring them together in one of their homes, speak about 

diabetes, and conduct cooking demonstrations right in their own 

kitchen. 

“The outreach really becomes a community event,” said Soto. 

“We also walk around the neighborhood so that folks can have experiences that fit their lives. But, sometimes, there are folks that want to 

go to a park, and we’ll do that. So our walking classes can be early 

morning or late evening, we set our hours based on what the community wants.” 

Barriers to Prevention 

Although Migrant Health Promotion has been successful in 

implementing its promotora model, barriers to effectively reaching 

those most at risk still exist. According to Regan, one of the primary 

barriers is transportation. Although the Rio Grande Valley has experienced phenomenal growth along the border, it is not yet considered 

a metropolitan statistical area. Because of this, many of the roads 

remain unpaved, and there is no public transportation. 

“Right now, we are a lot of smaller communities stretched out on 

one highway, and it still has a rural feel to it, because it’s agriculturebased,” said Regan. “One of the big issues for our migrant population 

is transportation, which makes the promotora model even more important and impressive. Promotoras are indigenous folk in the communities that are trusted and known, and live right there. We’re working toward getting the cities to chart out walking maps and safe 

lighted walking paths. That’s one of the things colonia [rural, unregulated, low-income neighborhoods] folks talk about a lot. There are 

dogs. Our streets are dirt, there’s not necessarily a safe walking place. 

So you know, access to parks requires systemic change.” 

“There’s a community word of mouth about promotoras and their 

work, so we always need more of them,” added Regan. 

“We can’t reach all of the people who need help and are asking for 

the intervention. Word of mouth gets out about the cooking classes, 

and walking classes, and the community really doesn’t understand 

that this is a research grant about health promotion intervention models. They see it more as a social service. We are having a little trouble 

from an administrative perspective because our control group wants 

the intervention. So, it’s hard to do this type of work, and remain in 

good graces with all of the residents.” 

This year, more than 20 promotoras have played key roles as educators, planners, evaluators, and leaders. The have received over 200 

hours of training in diabetes, nutrition, and physical activity and share 

this information with parents, teachers, students, colonia residents, 

patients at community health centers, and the community at large. In 

just the first six months of operating (October 2001-April 2002) 

community-based promotoras conducted nearly 1,200 individual educational encounters, and provided over 350 cooking classes for residents. 

“Our success is built on grassroots, grassroots, grassroots! The 

promotora model is about adapting, enhancing, supporting, and funding the models that already exist in the community.We see promotoras 

as being that model that works,” concludes Regan. 

For more information on Migrant Health Promotion and the use of 

promotoras in health education and promotion, contact Laura Regan, 

REACH program director at LLReganMPH@yahoo.com or 956-565­

0002.

Office of Minority Health Resource Center 2 U.S. Department of Health and Human Services